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General NPI Number Information
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NPI Number | 1326084807
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Entity Type | Organization
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Legal Business Name | BOB'S QUALITY EYEWEAR INC.
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Dates
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Enumeration Date | 06/21/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 63 W 3RD ST
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City | WINONA
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State | MN
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Zip | 55987-3432
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Country | US
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Telephone | 150-745-7990
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Fax |
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Provider Business Mailing Address
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Address Line | 63 W 3RD ST
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City | WINONA
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State | MN
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Zip | 55987-3432
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Country | US
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Telephone | 150-745-7990
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. ROBERT LEE ROTH
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Credential | OPITICAN
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Telephone | 15074579901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number |
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License Number State |
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